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Annie's junior year abroad marked the low point in her weight -- a mere 85 pounds on her lanky 5' 7" frame. But it was not the low point of despair in her 10-year battle with eating disorders.
Annie hit bottom, surprisingly enough, when she seemed most well.
A few years after she returned from Europe, she had graduated from college, gotten married and accepted a job. She was no longer anorexic, but she was not cured by any means.
"I was lowest when I started to let go of the eating disorders as a way of life," said Annie. "I thought I would not have a life or be anyone without them."
Annie, Dr. Margaret S. Ross of the MIT Medical Department and others participated in an IAP session sponsored by MIT Medical on eating disorders (MIT Tech Talk, January 14). Their goal is to show others that, like Annie, they might emerge intact from the living hell of eating disorders, and that there is help available.
While her husband was in graduate school, Annie found Dr. Ross, a staff psychiatrist in the MIT Medical Department. "I owe her my life," she said.
"At about 125 pounds, I looked most normal to the world when I was most at risk for suicide or a heart attack from electrolyte imbalance," she said. "I had no hope, no vision for myself. I was caught between not wanting to continue like I was, and not thinking there was any other way to be."
A PROBLEM ON THE RISE
Depriving oneself of food to the point of collapse or gorging on huge amounts of food only to vomit afterward seems unimaginable. Yet this is a way of life to increasing numbers of women and men of all backgrounds and nationalities. Experts estimate that 5 percent of adolescent and adult women and 1 percent of men have anorexia, bulimia or a binge-eating disorder. Magazines describe teen-aged girls gathering in social groups to binge and purge.
The number of cases of anorexia has doubled in the past two decades, reaching the highest level since the disease was labeled in the 1800s. Some of this rise may reflect an increase in awareness, and some an increase in incidence.
While those figures are disturbing, there are even more people who are not clinically diagnosed with an eating disorder, but for whom food is a serious, preoccupying issue.
"Those who look at only those who meet the criteria for a full-blown case of the illness are seeing only the tip of the iceberg," Dr. Ross said. "Many people suffer from subclinical illness; there is evidence of this everywhere," including elite private institutions such as MIT.
"These illnesses are similar to addictions, as difficult to treat as smoking, drugs and alcoholism, and they are equally beyond the patient's ability to control," said Dr. Ross, who treats people from all sectors of the MIT community. "They are difficult to diagnose because bulimic patients feel shame, and want to hide their symptoms, and anorexic patients honestly do not think there is anything wrong with them."
Dr. Ross explained that the outward symptoms are only markers for the real problem, which has much more to do with sense of self than it does with food. The starvation of anorexia and the binging and purging of bulimia are coping strategies. Although they're not healthy strategies, they can't be given up immediately. They have served as a lifeline, and must be respected until healthier adaptations can be formed.
While the causes are many, the obsessions that contribute to these eating disorders can be a distortion of the characteristics that help someone succeed at MIT: being an overachiever; having a tendency to internalize pressures; or being structured, perfectionist and driven.
College campuses contribute to eating disorders because they are temporary homes where people sometimes have a hard time establishing healthy eating habits or, if they have struggled with eating disorders before they arrived, continuing their treatment.
"MIT is a pressure-filled environment of achievers who have high expectations for themselves," said Annie, who was a dean's list student at Smith College. "Expectations are motivating, but somewhere the lens needs to stay in focus, and people need to recognize that the human beneath the accomplishments may need feeding of the body and spirit."
Annie cited several difficulties while growing up, including the death of her father and being raised by her grandparents for part of her childhood, that may have contributed to her eating disorder. Her home life was unpredictable, so she kept her problems to herself.
"These are the things that the eating disorder -- in a sick, perverse way -- helped me cope with. I thought that if I gave up my food habits, I would have anger and grief and I would implode," she said. "None of my problems was insurmountable. To me, they just seemed that way."
"An eating disorder causes havoc in a person's life," Dr. Ross said. "Although the symptoms may start as a way for her to maintain a sense of control, too often the disease quickly takes over. The disease begins to control her."
Annie recalled how she lived each day in terror of being offered a bite of what she called "unplanned" food. She once bought a birthday cake inscribed with a fictitious name so no one would know she planned to eat the entire cake herself. She broke her knee from lack of calcium and continued to run 75 miles a week when she could barely walk.
Despite these things, Annie's eating disorder was her secret for 10 years.
A NATIONAL PROBLEM
Sometimes it seems like America has a collective eating disorder. "We're busy, we're stressed, we never sit down in a relaxed way," Dr. Ross said. "Dinner is disjointed and rushed. And we don't have any real reason to move. We don't walk anywhere, we don't even get up to change the channel on the TV.
"Food of every kind is always available -- maybe too available. Combine these facts with a lot of misinformation and wrong thinking about nutrition, and you come up with an entire society prone to eating problems."
Dr. Ross noted that from their earliest consciousness, girls are bombarded with media images of women who are unrealistically thin. From as early as age five, girls seem vulnerable to thinking they should restrict their food intake, setting themselves up potentially for a lifetime of rollercoasting weights and a cycle of deprivation, inevitable breakthrough eating, guilt and attempts to diet or purge.
"It is now clear that the very act of limiting food intake can precipitate the psychological and physiological changes seen in those with eating disorders," she said.
Although disease is an extreme, the underlying elements of eating disorders are not uncommon, which may be why more men and women from different social and ethnic groups are falling prey to a disease once primarily restricted to white, upper-middle-class girls.
Recent research indicates there may be genetic and hormonal as well as psychological factors involved. Eating disorders seem to run in families. Adolescents, already going through a difficult period of separating from their parents and becoming subject to increasing scrutiny from their peers, are especially prone to eating disorders.
LIFE BEYOND THE CURE
When Annie, now 36, looks back, she says what she deplores most is how much of her life's energy was wasted on eating, not eating, and controlling what she ate. Then there was the huge effort that went into the subterranean life of excuses, secret binges and lies.
Even when she decided she needed help, the recovery process took time, effort and was full of setbacks. She went to a series of therapists without making much progress.
Dr. Ross was different, Annie said, because she worked very slowly, establishing trust before she asked her to even try to change her habits.
Annie painstakingly learned to use coping mechanisms that most people take for granted: talking with friends, finding the humor in a predicament, going for a walk in the woods, petting her cat. Her friends, family and sense of humor bail her out during the tough times.
She says she still has the personality traits -- a tendency toward perfectionism, being worried that people won't like her if they really knew her -- that contributed to the disorder. "Now those traits don't come out around food. I can eat a big Christmas dinner and lie on the floor with my family and joke about how lazy we are," she said.
Annie works two days a week and enjoys her daughter and son. She weighs a healthy 135 pounds and exercises, but not compulsively. She looks in the mirror and knows that there is nothing wrong with the fact that she is never going to look like a model on the cover of Cosmopolitan.
To Annie, a friend put it best: Everyone has baggage, he said. The point is whether you choose to stow it away or carry it around with you. "I used to carry it all, and add some," Annie laughed.
Resources are available to any member of the MIT community who has concerns about food and body image. They include:
Medical Department -- Dr. Bethany Block in Internal Medicine, x3-7803, email@example.com; Dr. Margaret Ross in Mental Health at x3-2916, firstname.lastname@example.org; Anna Jasonides in Nutrition, x3-1546, email@example.com.
Health Education -- Tracy Desovich, x3-1316, firstname.lastname@example.org.
Outside MIT -- Massachusetts Eating Disorders Association, (617) 738-MEDA.
A version of this article appeared in MIT Tech Talk on February 25, 1998.